Pérez Carlos, Solías Yoanet, Rodríguez Gerzaín
Departamentos de Medicina Interna y Servicio de Dermatología, Hospital Militar Central, Bogotá D.C., Colombia.
Biomedica. 2006 Dec;26(4):485-97.
A patient with a leishmaniasis-Aids co-infection was presented and discussed..
A 29-year -old soldier, coming from the Province of San José del Guaviare, Colombia, complained of a weight loss of 18 kgs in the previous ten months as well as a two-month-old cutaneous leision. Elisa and Western blot tests were positive for HIV infection. LT CD4 were 92/mm3. He had a generalized erythematous, psoriasiform dermal lesion, which, upon biopsy, revealed an abundance of phagocytosed microorganisms that stained black with Gomory's technique. Disseminated histoplasmosis was diagnosed. The patient received anti-retroviral therapy and itraconazole, without regression of the lesions. Amphotericin B was beneficial but the lesions recurred several months later, more numerous, nodular and with occurrence in the oral mucosa. Nine months after the initial diagnosis additional skin biopsies and review of the previous biopsies established that the patient had diffuse cutaneous leishmaniasis. The leishmania parasite did not grow in culture. Miltefosine produced marked improvement, but the lesions recurred and were cured finally with 52 Glucantime injections administered for two months. Presently, the patient remains in good condition 21 months after diagnosis of leishmaniasis.
Diffuse cutaneous leishmaniasis may be a common clinical manifestation when leishmaniasis and AIDS co-occur. Its treatment is difficult and must include an antiparasitic drug as well as prophylactic, and anti-retroviral therapy. Leishmania amastigotes typically are not Gomory-positive and can be differentiated from Histoplasma by morphology, immunohistochemistry, culture, antibody-specific response and PCR. The leishmaniasis-AIDS co-infection enhances invasive capacity for both causal microorganisms. Increasing case numbers can be expected in Colombia, due to the high frequency of both diseases.
介绍并讨论一例利什曼病与艾滋病合并感染的患者。
一名29岁的士兵，来自哥伦比亚瓜维亚雷省圣何塞德尔，主诉在过去十个月体重减轻了18公斤，并有一个两个月大的皮肤损伤。酶联免疫吸附测定（ELISA）和蛋白质印迹法检测显示HIV感染呈阳性。淋巴细胞表面抗原CD4计数为92/立方毫米。他有全身性红斑、银屑病样皮肤损伤，活检显示有大量吞噬的微生物，用戈莫里氏染色法染成黑色。诊断为播散性组织胞浆菌病。患者接受了抗逆转录病毒治疗和伊曲康唑治疗，但损伤未消退。两性霉素B治疗有效，但几个月后损伤复发，数量更多，呈结节状，且出现在口腔黏膜。初次诊断九个月后，再次进行皮肤活检并复查之前的活检结果，确定患者患有弥漫性皮肤利什曼病。利什曼原虫在培养中未生长。米替福新治疗有明显改善，但损伤复发，最终通过两个月内注射52次葡糖胺锑钠治愈。目前，该患者在被诊断为利什曼病21个月后状况良好。
当利什曼病和艾滋病同时发生时，弥漫性皮肤利什曼病可能是一种常见的临床表现。其治疗困难，必须包括抗寄生虫药物以及预防性和抗逆转录病毒治疗。利什曼无鞭毛体通常对戈莫里氏染色呈阴性，可通过形态学、免疫组织化学、培养、抗体特异性反应和聚合酶链反应与组织胞浆菌相鉴别。利什曼病与艾滋病合并感染增强了两种致病微生物的侵袭能力。由于这两种疾病的高发病率，预计哥伦比亚的病例数会增加。
